Delirium is one of the most common yet most elusive syndromes in the ICU, marked by fluctuating disturbances in awareness and attention arising from complex, multifactorial pathophysiological processes. Despite decades of research and the identification of numerous risk factors, delirium continues to evade full understanding and remains a major therapeutic challenge. Its consequences are profound: higher morbidity and mortality, prolonged ICU and hospital length of stay, and a substantial economic burden of thousands of dollars in excess costs. Beyond being a clinical complication, delirium has become a silent disruptor of modern critical care. This raises an urgent and challenging question: rather than endlessly treating the aftermath of delirium, could the key breakthrough lie in reimagining the ICU itself? Transformative investments in architecture, infrastructure, and human-centered design—together with elevating nonpharmacological strategies alongside pharmacological therapies—may hold the potential to prevent delirium at its roots. In this narrative review, we synthesize current knowledge on the epidemiology, etiology, pathophysiology, diagnosis, prevention, and management of ICU delirium. We highlight how innovative ICU redesign, holistic care approaches, and integrated evidence-based strategies may reshape the fight against delirium, turning the ICU into not just a site of survival but a therapeutic tool in its own right.

Background: Optimal energy and protein delivery during the early phase of severe trauma remains unclear. Observational studies frequently contradict the findings of randomized controlled trials, raising concerns about confounding factors. The aim of this study is to assess nutritional adequacy and daily variability in the energy gaps and its impact on outcomes using innovative statistical methods. Methods: Prospective observational study enrolled severely injured patients in the ICU at the Level 1 trauma center between October 2023 to April 2025. To describe the evolution of calorie and protein deficits during the first 10-day ICU stay, we utilized a linear mixed-effects model to estimate each patient’s individual energy gap trajectory. Results: 286 patients were analyzed. Median APACHE II and ISS score was 16.0 (12.0–20.0) and 22.0 (18.0–27.0), respectively. Mortality rate was 35.3%. Patients received 68.3% of prescribed calories and 76.8% of proteins. Admission energy deficit, rate of caloric intake, and their interaction are associated with ICU mortality. Increased day-to-day energy variability was associated with longer duration of mechanical ventilation (HR = 0.55, 95% CI: 0.31–0.99; p = 0.047). Patients who achieved better caloric (HR = 0.68, 95% CI: 0.48–0.98, p = 0.036) and protein (HR = 0.29, 95% CI: 0.09–0.96, p = 0.043) nutrition had a lower hazard of developing nosocomial infection. Conclusions: This study supports the 2023 ESPEN guidelines, showing that achieving the recommended energy and protein intake during the early phase of severe trauma is linked to lower mortality rates, shorter mechanical ventilation time, and reduced risk of nosocomial infections.

Ultrasound has predictive value of identification and management of reversible causes of cardiac arrest on the outcome after applied CPR, in terms of ROSC (return of spontaneous circulation) and the hospital discharge and neurological findings after applied CPR measures. Ultrasound is used in all phases of resuscitation including period before cardiac arrest, during cardiopulmonary resuscitation (CPR), and in the period after that. Ultrasound use during CPR offers numerous advantages including non-invasiveness, easiness, the short time for examination and a safe possibility for a repeat test whenever it is needed. Focused Echocardiography Examination in Life support (FEEL) and Focused Echocardiographic Evaluation in Resuscitation (FEER) protocols are mostly used when we talk about heart examination in cardiopulmonary resuscitation.

Introduction: Trauma represents one of the most significant problems in public healthcare worldwide. It is one of the leading causes of mortality, particularly among children and young adults, but with a significant majority of non-fatal injuries that result in lifelong disabilities and health consequences. Proper and timely identification of patients with a higher risk of mortality is crucial for better outcomes in patients who suffer from trauma. The aim of this study is to identify potential predictors of in-hospital mortality among patients who suffered trauma and are treated in the ICU (Intensive Care Unit). Methods: The retrospective cohort study was conducted in a trauma, 12-bed ICU at the University Emergency Centre, University Clinical Centre of Serbia, Belgrade. All consecutive patients with blunt trauma were admitted to the ICU between August 2021 and August 2022. The primary outcomes of interest were all-cause in-hospital mortality. A value of p < 0.05 was considered statistically significant. Results: GCS (Hazard ratio 0.924 95%CI 0.873-0.979), vasopressors (Hazard ratio 3.47 95%CI 1.373-8.787) and age (Hazard ratio 1.030 95%CI 1.014-1.047) can independently predict in-hospital mortality. Conclusion:This study suggests risk factors for unfavorable clinical outcomes after severe trauma. It may be essential to properly and promptly differentiate between individuals with lower prognoses, which can lead to prompt and more aggressive treatment of these patients and might decrease in-hospital mortality. Age, vasopressors and mechanical ventilation, in particular, may be helpful indicators of in-hospital mortality of traumatized patients treated in the ICU.

Trauma is still the leading cause of death in the world among the population under the age of 45 and bleeding is the dominant cause of early mortality in one third of all injured. Coagulopathy in trauma is directly related to the outcome and is considered to be the most significant preventable cause of death. Trauma-induced coagulopathy is a complex, multifactorial disorder that can be roughly divided into three phases. The entity of acute traumatic coagulopathy is characterized as an endogenous hemostatic disorder that occurs in the first few minutes of injury associated with tissue damage caused by severe trauma and hemorrhagic shock, regardless of external factors. The pathogenesis of trauma-induced coagulopathy is not fully known and is still the subject of research. According to the latest recommendations of the European Guide for the Management of Massive Bleeding and Coagulopathy in Trauma, tranexamic acid should be used as soon as possible, and no later than three hours after the injury in a patient who is bleeding or at risk of significant bleeding. Its prehospital application should be considered. In the light of new knowledge, the question of the justification and safety of the free use of tranexamic acid in trauma has been raised. The use of tranexamic acid in trauma-induced coagulopathy is a simple and affordable therapeutic approach that should be used in the prehospital period in those patients who are bleeding or at risk of significant bleeding. The implementation of this therapy in our country has not yet come to life.

Background: Bladder neck preservation (BNP) has been adopted in open (ORP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP). However, there are concerns that this technique can compromise oncological outcome and increase positive surgical margins (PSM). The aim was to evaluate the outcome of BNP, focusing on surgical and pathological outcomes, as well as biochemical recurrence (BCR). Methods: We prospectively collected demographic and clinical data from 170 consecutive patients who underwent ORP and LRP between 2014 and 2020. ORP was performed in 63 patients, and the rest underwent LRP. BNP was performed in 85 patients. Results: PSM were found in 24.7% of patients. Of patients with BNP, 22.4% had PSM. There was no significant statistical difference between patients with or without BNP in the form of PSM. Base-positive margins were detected in 9.4% of patients with BNP and in 5.9% of patients without BNP with no statistical significance. Bioptic Gleason score, clinical stage, and preoperative PSA were statistically significantly correlated with PSM. BCR was more common in patients without BNP (23.5%) vs. non-BNP (21.2%). The only statistically significant predictor of BCR was PSM. Conclusion: This study suggests that BNP in RP is not associated with an increased level of PSM. Preoperative PSA, bioptic Gleason score, and clinical T stage of disease were identified as predictors of PSM occurrence.